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Obamacare mandate may be ‘mandate plus’

America’s Health Insurance Plans, the main trade group for health insurance companies, has asked HHS to impose late enrollment fees, so people who don’t sign up until they need the coverage will pay more than people who enroll right away. It’s the same concept that Medicare uses now for doctors’ and prescription drug coverage: Seniors don’t have to enroll right when they turn 65, but if they wait too long, they pay a penalty when they do sign up — and their premiums will always be higher as a result.

The insurers have suggested other penalties for people who delay, such as not letting them choose the most generous health plans and allowing insurers to impose waiting periods.

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The Blue Cross and Blue Shield Association is asking HHS for the late enrollment fees and penalties, too. The National Association of Health Underwriters, which represents health insurance agents and brokers, called for late enrollment penalties too, warning that the impact on premium costs would be “enormous” if too many people wait until they’re sick or injured to buy coverage.

And the American Academy of Actuaries — the people who crunch all the numbers for health insurers’ costs — suggested late enrollment penalties and other measures, like not letting people sign up for coverage as often and requiring small employers to sign their workers up automatically.

It’s all a critical part of the smooth launch of the exchanges — which, if all goes well, will be the health plan marketplace for people with pre-existing conditions, and for those who can’t get covered through another source, like their employers or Medicare.

“There’s broad agreement that in order for the exchanges and the insurance market reforms to work, the coverage needs to be affordable, and there needs to be as many healthy people in the risk pools as possible,” AHIP spokesman Robert Zirkelbach said.

Some of these ideas used to be discussed as lighter alternatives to the individual mandate, which Congress would have to pass to add them to the health care law. But now, these groups are asking HHS to impose the measures on its own, saying it has the power to keep the health insurance market stable in the first two years.

It’s also an acknowledgment that, with the toxic politics of a divided Congress and lasting Republican opposition to the health care law, the chance that Congress would pass any legislation to help Obamacare work better is pretty much zero.

“Ever since the beginning of this, we’ve been concerned about the strength of the mandate,” said Cori Uccello, a senior health fellow at the American Academy of Actuaries. “These same kinds of things can be used to strengthen the mandate. They don’t need to be seen as an either/or.”